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Will we ever see government ambitions to transform community services achieved?

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The sunshine we’ve enjoyed over the last few days suggests spring is on the way at last, but winter seems reluctant to loosen its icy grip on the health service.

The proportion of patients spending more than four hours in accident and emergency rose to 15.6% in January – the highest ever in this set of data, according to latest NHS perfomance figures.

New monthly combined performance and weekly winter performance data from NHS England also reveals that only two major A&E departments met the four-hour target.

“The service is inexorably and inevitably losing its battle against targets”

However, the data shows that the NHS treated an extra 75,670 patients within four hours compared with last year.

Total attendances in January were 2,112,000, a rise of 5.6% year on year, while the 564,000 emergency admissions were 7.2% higher than last year and the highest number on record.

So, what does all this tell us? Basically, that patient numbers are rising relentlessly, and NHS staff and the service in general are getting better and better at dealing with them. However, the service is inexorably and inevitably losing its battle against targets.

This situation cannot be allowed to continue indefinitely. That would surely see the day when everyone in the country was either a patient being treated or an employee of the NHS.

However, more seriously, we have been talking about this issue for years, most notably the need to boost use of community services to both prevent admissions and get people home again safely after their acute stay.

The NHS Long Term Plan repeats this ambition, with emphasis on community-based rapid response teams that will be expected to swing into action within two hours to prevent vulnerable patients being taken to hospital as part of efforts to provide more care closer to home.

Implementation of such initiatives cannot come soon enough. According to analysts at the Nuffield Trust “today’s figures remind us that the NHS is fighting a losing battle in trying to meet its commitments to provide timely healthcare in the face of the pressure it is under”.

“This situation has a serious impact on hundreds of thousands of patients, and will be demoralising for many staff,” the think tank warned.

Meanwhile, NHS Providers, which represents health service organisations, said the figures showed winter demand for NHS care had “once again put significant strain on trusts and staff”.

It also noted that the rise in the numbers being treated was “largely down to the work trusts have been doing to improve patient flow and reducing the time patients spend in hospital”.

“Improved joined-up working with partners in the community and primary care is also helping to support trusts to manage demand better,” it stated.

But like other potentially catastrophic issues, such as climate change and antibiotic resistance, we discuss the problem and potential solutions endlessly but never seem to get on with tackling it.

Way back in 2008, we had the Delivering Care Closer to Home – a 56-page plan entirely devoted to resolving the problem of too many patients being treated in acute settings. Whatever happened to that?

”It would be wonderful to one day be able to write about this problem as a thing of the past”

Then, to much fanfare, in 2015 we had the announcement of sustainability and transformation partnerships that were (sorry are) intended to drive integrated care at local level, again with the ultimate ambition of keeping patients out of hospital.

STPs have now evolved into what NHS England calls integrated care systems but we still largely await the revolution in change, as the figures published yesterday clearly demonstrate.

It would be wonderful to one day be able to write about this problem as a thing of the past. Here’s hoping. But for now, I want to pay tribute to the hard work of all the nurses in every setting working towards this ambition.

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